Audit of Singleton Breech delivery in a Secondary Healthcare Facility in Abuja, Northcentral Nigeria.

Singleton Breech delivery in Abuja

Abstract

Background: The management of singleton breech presentation and delivery at term has remained a subject of controversy in obstetric practice. The Term Breech Trial (TBT) seemed to have resolved the controversy with its findings in favour of planned Caesarean section (CS) for breech delivery for favourable perinatal outcome. However, studies conducted after the TBT were in favour of planned vaginal breech delivery in selected cases.                                                                                 

Aim: The aim of this audit was to determine the incidence, mode of delivery and outcome of breech delivery in Maitama District Hospital Abuja, Northcentral Nigeria.

Materials and Method: This was a retrospective audit of all singleton breech deliveries conducted at the Maitama District Hospital (MDH) Abuja, over a 4-year period, between 1^st January 2019 to 31^st December 2022. Data were extracted from the electronic database of the hospital’s Electronic Medical Records system, as well as the labour ward and theatre registers, and analysed using Statistical Product and Services Solution (SPSS) version 26. The results were presented in tables as frequencies and simple percentages.

Results: During the study period, there were 6,438 deliveries. Out of these, 111 were breech deliveries, giving an incidence of 1.7%. Majority, (83.6%), were booked. Multiparous women accounted for 59.1% and primigravidae 40.9%. Term breech deliveries accounted for 90.9%, while 9.1% were preterm deliveries. Caesarean section was the commonest mode of delivery, (70.9%), especially, among the primigravidae. There was a total of 106 live births and 4 perinatal deaths, giving a perinatal mortality rate of 38/1000 live births. Perinatal and maternal outcomes were generally good. There was no maternal death.

Conclusion: The incidence of breech presentation is low in this study with a preponderance in multiparous women. The high CS rate, especially among primigravidae, can be reduced through appropriate case selection, training on skills for conduct of assisted vaginal breech delivery, and institution of protocols for management of breech presentation, including the practice of external cephalic version (ECV).

Key words: Breech delivery, singleton breech, perinatal outcome, maternal complication